Psychological factors in the etiology of ulcerative colitis: objectlessness and rage. In this second investigation of psychological factors in the etiology of ulcerative colitis, the author again utilizes unusual cases characterized by limited variables preceding illness. The first investigation involved several patients whose partial deafness antedated their illness. A significant point was that prior to developing their illness, all these patients had arrived at a state of objectlessness which was abetted by the deafness. This report presents four ulcerative colitis patients with pre-existing organic problems affecting their mental status. Two of the patients are severely mentally retarded. A third patient has rapidly advancing multiple sclerosis, and a fourth--actually an addition to the earlier study--has long-standing partial deafness. Aside from the objectlessness which was also prominent in the earlier group, all four patients demonstrate a consistent pattern of vicious self-directed rage. This paper takes into account the interaction between the rage and the state of objectlessness in the production of illness.


Pediatric referrals to psychiatry: I. Comparison of referrals and nonreferrals. Age, sex and duration of hospital stay of 220 patients consecutively referred to psychiatry (Group I) and of their fellow 2065 nonreferred patients (Group II) were compared. Overall, Group I was significantly older, remained in hospital longer, and included more girls than boys, whereas Group II included slightly more boys than girls. Separation of Group II into those whose primary discharge diagnosis was psychiatric or nonpsychiatric revealed that mean age and duration of hospital stay of the former were almost identical, and the sex distribution was similar, to those of Group I. These findings suggest that children referred for psychiatric evaluation differ from their nonreferred fellows discharged with a nonpsychiatric diagnosis but not from nonreferred fellows discharged with a psychiatric diagnosis.


Michael and Christine confront their elders. This article is an account of an incident at a special school, involving a pupil, a young teacher, and two senior members of staff. The article offers some reflections and conclusions on the special challenges to be faced when making relationships with the young. Reference is made to Winnicott, Lomas, Bridgeland et al, in suggesting connections between the insights and skills of both therapy and of teaching.


The analysis of therapeutic failure.

The analysis of therapeutic failure.


Body image and gender identity.

Body image and gender identity.


Some experiences through family-psychotherapy for psychotics in Japan. My experiences of family-psychotherapy for psychotics in Japan, are discussed. The emphasis is put on the emotional problems which had been elicited among the hospital staffs; nurses, psychologists, and social workers. Applying a new type of the therapy, such as family-psychotherapy, has important factors beside the theoretical effect of them. We divided the course of family therapy into four clinical stages, from fragmented way of communication in the family to integrated one. My experiences which I have had in Japan, where the psychiatry itself has had a organic orientation, seem to be very helpful for those countries where the family-psychotherapy is not popular yet.


The addictive personality--narcotics addiction.


Iroquois herbalism: the past 100 years.

Iroquois herbalism: the past 100 years.


An eye mobile screening unit.

An eye mobile screening unit.


Psychiatric problems of the 1970's.

Psychiatric problems of the 1970's. This paper describes some of the social trends of the 1970's that may be affecting patterns of psychiatric needs and presents data showing their impact. It suggests possible psychiatric and sociopolitical responses to meet these needs. Patients were studied in the outpatient and inpatient services of the Shands Teaching Hospital and Student Mental Health Services at the University of Florida. The main findings were that single youth, both females and especially males, were requiring less help since the winding down of American participation in the Vietnam War, perhaps indicating that youth are feeling less alienated from the national effort. Black women are seeking help more than ever before, probably because the black liberation movement has offered them hope that psychiatry can help them. Despite the women's liberation movement, white women still remain the largest group of psychiatric outpatients, as they were in the 1950's and 1960's.


Pediatric referrals to psychiatry: II. Factors relating to delays in referral. Delays in  requesting psychiatric consultation were examined, in relation to 220 referrals from a medical ward in a pediatric hospital, to determine why children referred for psychiatric evaluation remained in hospital longer than the non-referred. Request delays did not correlate with age, sex, or length of hospitalization, but were likely to be shorter for acutely ill patients and those whose admission diagnosis evidenced the pediatrician's awareness of the possibility of significant emotional factors. The onus may be on the psychiatrist to increase the medical staff's awareness of the possibility that emotional factors often contribute to their patient's ills. This increased awareness may result in prompt referrals to psychiatry, and shorter, less costly hospitalization.


A case of chronic factitious illness.

A case of chronic factitious illness. A twenty-four-year-old woman is presented with multiple previous hospitalizations for joint and muscle pains. Guarded in her description of symptoms, she reports that "lupus" has been diagnosed at several hospitals over the past few years, unable to recall the name of any other than on previous hospital. The medical work-up failed to show any abnormality except that compatible with previously diagnosed von Willebrand's disease. In the discussion of the case, the patient's desire to be taken care of is seen as a major dynamic, causing her to fabricate illness. The diagnoses of Munchausen Syndrome, malingering, conversion reaction and hypochondriasis are discussed and differentiated from each other, and the treatment of Munchausen Syndrome is discussed.


Routine tonometry: a demonstration project.


A phase in the psychotherapy of a juvenile onset diabetic patient. The psychotherapy of a juvenile onset diabetic patient, who initially presented with problems of poor diabetic management and depression, is discussed. Pertinent details of the first two years of treatment are presented to show the interrelationship between the medical and psychiatric problems. The patient severely mismanaged her illness around the tenth anniversary of her father's death. The patient's behavior and attitude toward her own illness were associated with guilt relating to the death of her father, also diabetic. During the anniversary period the patient was able to gain insight into the dynamics of her behavior, and from then on, succeeded in adequate management of her diabetes. The events in this case are linked to relevant literature.


Control of hypertension with single daily doses of sotalol hydrochloride. A study was carried out in 12 previously untreated hypertensive patients to assess the efficacy of sotalol given in a once-daily dosage regimen. After an initial dosage titration period (mean 3 weeks) during which diastolic pressure was stabilized at less than 100 mmHg, all patients were satisfactorily maintained on a constant once-daily dose of sotalol for 3 months. Eight of the 12 patients required 320 mg or less daily (mean dose 190 mg). Whilst blood pressure remained controlled for at least 26 hours after daily doses the pulse rate, counted at the same time, showed escape from beta-blockade. Side-effects (vivid dreams) were reported in only 1 patient.


The effect of pentoxifylline ('Trental') on cerebral blood flow: a double-blind study. A double-blind, placebo controlled crossover study was carried out in 20 geriatric patients with cerebrovascular insufficiency ot asses the effect of pentoxifylline on cerebral blood flow. Using 99m Tc cerebral scinitigraphy and a gamma comera/computer system, the pattern of blood flow in 5 brain areas was manitored after a single intravenous infusion of 200 mg pentoxifylline (10 ml) and after 10 ml saline solution. The results showed that, with the exception of one brain area, there was a statistically significant increase both in regional and hemispheric cerebral blood flow after pentoxifylline. It is of particular interst that global hemispheric blood flow, which gives an indication of total blood supply to the brain, showed approximately the same percentage increase on both sides with pentoxifylline.


Reactivity of the beta-93 SH groups in Hb Köln. The beta-93 SH groups were found to be present in freshly purified Hb Köln, but over a period of several days storage they gradually oxidized to form inter-beta chain disulfide bonds. It is suggested that this gradual oxidation accounts for the low SH values which have been reported. The SH groups of Hb Köln were also found to react more readily than normal with H2O2 and O2-.


Human studies on the bioavailability of a quaternary ammonium compounds, tiemonium iodide and tiemonium methosulphate. Five volunteers were administered capsules containing 14C-labelled tiemonium iodide and 4 volunteers received capsules of 14C-labelled tiemonium methosulphate. Serum, urine and faecal levels of tiemonium were measured. The percentage of the dose absorbed was determined after a further labelled intravenous injection into 3 of the volunteers. The drug appeared to be poorly absorved, as expected for quaternary ammonium compounds, but there was no difference in the bioavailability of these two tiemonium salts.


Pre-clinical toxicological studies with muzolimine. Toxicological studies were carried out to assess the acute, sub-chronic and embryotoxicity of muzolimine, administered orally to a number of animal species. The results showed that muzolimine had only slight acute toxicity, of the same degree in the mouse, rat, rabbit and dog. In the sub-chronic toxicity studies over 90 days, the presenting symptom in rats and dogs was a pronounced diuresis and, apart from the kidney, no other organ or organ systems were impaired. Macroscopic and microscopic changes in the kidney were the pharmacological result of overdosage, i.e. excessive diuresis, and not due to typical toxic renal damage. Embryotoxicity studies on pregnant rats and rabbits showed that toxic (rat) or lethal doses (rabbits) had no embryotoxic or teratogenic effects.


Separation of human hemoglobins by DEAE-cellulose chromatography using glycine-KCN-NaC1 developers. This chromatographic procedure uses DEAE-cellulose as ion exchanger and glycine-KCN-NaC1 solutions as developers. Blood samples from several adults and newborn infants with alpha, beta, delta, or gamma chains variants have been analysed. The hemoglobins are eluted as compact and symmetrical zones, and the separation of many hemoglobin types is greatly improved. The procedure is relatively fast, simple, and inexpensive.


Hemoglobin Riyadh--alpha2beta2 (120(GH3)Lys replaced by Asn). A new variant found in association with alpha-thalassemia and iron deficiency. On a field trip toSaudi Arabia (M.A.F.E.H.) in which the relationship between alpha-thalassemia and iron deficiency was studied, a fast moving hemoglobin variant was noted in a 30 year old Saudi Arabian woman. Analysis of the hemoglobin variant showed that the amino acid substitution was beta120 Lys replaced by Asn. This variant had not been described previously and has been named Hb Riyadh. There was also present an alpha-thalassemia and details are given of the imbalance of globin chain synthesis. It was possible to improve considerably the balance in vitro by the addition of hemin.


beta+-Thalassemia trait: hematologic and hemoglobin synthesis studies. In Thailand, two types of high Hb A2-beta-thalassemia genes: beta0-thalassemia (beta0-thal) or classical beta-thalassemia and beta+-thalassemia (beta+-thal) or mild beta-thalassemia exist. This study presents hematologic data and globin chain synthesis in peripheral blood of the genuine beta+-thal heterozygotes in comparison with those of the beta0-thal heterozygotes. Thirty individuals of Thai and Chinese extraction with the beta+-thal heterozygosity were hematologically examined. The hematologic means of hemoglobin concentration, MCV, MCH, MCHC, Hb A2 and alkali denaturation hemoglobin of the beta+-thal traits were, 11.7 g%, 67.8 mu3, 21.5 gammagamma, 32.1%, 4.94% and 1.20% respectively. These were not statistically different from those of the beta0-thal traits of our previous study(1). The globin chain synthesis in reticulocytes were performed by incorporation of 3H-Leucine for 3 hours. The mean of total radioactivity alpha/beta ratio in 11 normal controls was 1.07 +/- SD 0.03. The mean of alpha/beta ratio in 9 beta+-thal traits was 2.03 +/- SD 0.10 which was significantly different from that in 7 beta0-thal traits of 2.28 +/- SD 0.07. Our globin chain synthesis thus appears to be helpful of discriminating the beta+-thal trait from the beta0-thal trait.


Hemoglobin Baylor (alpha2beta281(EF5) leu replaced by Arg)--an unstable mutant with high oxygen affinity. The amino acid substitution in a new hemoglobin variant, Hb Baylor (alpha2beta281 (EF5) Leu replaced by Arg), has been determined by application of column chromatography and amino acid analysis of the tryptic peptides. The hemoglobin is somewhat unstable and it has a high oxygen affinity. The propositus shows the opposing hematologic effects of these two properties--the instability being associated with increased destruction, and the high O2 affinity with increased production, of erythrocytes.


Homozygous cases for hemoglobin J Mexico (alpha54 (E3)Gln replaced by Glu) evidence for a duplicated alpha gene with unequal expression. Hemoglobin J Mexico has been found in five generations of a large Algerian family. Nine subjects have 55% Hb J although their parents, siblings and offspring may have 31%, the usual quantity found in heterozygotes. Those with 55% Hb J are considered to be homozygous for a chromosome carrying both a normal alpha chain locus and a locus for alphaJ. The proportion of the abnormal hemoglobin in all the subjects is in favor of an unequal expression of both loci, the amount of protein synthesis directed by the alpha J gene being greater than that directed by the alpha A. In two heterozygotes a slightly higher proportion of the Hb J (38%) suggests the presence of a single normal alpha chain locus in trans. An associated alpha-thalassemia was excluded by biosynthetic studies in this family.


The combination of HB S and HB E in a black female.


Hemoglobin Willamette (alpha2beta2 51Pro replaced by Apg (D2)) a new abnormal human hemoglobin. A hemoglobin variant with the same electrophoretic mobility as hemoglobin S was found in three generations of a black family. No clinical symptoms or findings were present in subjects heterozygous for this mutant. Except for target forms of mature erythrocytes, they have no abnormal hematologic findings. Structural studies demonstrated a previously undescribed substitution, beta51 Pro replaced by Arg, in the abnormal fraction which accounts for about one-third of the total hemoglobin. This fraction is more unstable in vitro at 65 degrees than normal A hemoglobin. Both whole blood and purified abnormal hemoglobin have increased oxygen affinity and a slightly decreased Bohr effect.


Hemoglobin British Columbia (alpha2beta2 101(G3)Glu replaced by Lys). A new variant with high oxygen affinity. Hemoglobin British Columbia was found in an East Indian living in Vancouver, British Columbia, Canada. Its structure was demonstrated to be alpha2beta2 101(G3)Glu replaced by Lys. It has a significant increase in oxygen affinity, decrease in heme-heme interaction, but normal Bohr effect. Unlike Hb Rush (beta101 Glu replaced by Glu), it is as stable as Hb A to heat and alcohol denaturation. By both cellulose acetate electrophoresis and chromatography the undissociated Hb British Columbia moves between Hb S and Hb A rather than behaving like Hb C. However, the dissociated abnormal beta chain behaves like beta C. The substitution is at the alpha2beta2 contact region. Except for a mild erythrocytosis, the propositus has normal hematological findings.


Another form of the hereditary persistence of fetal hemoglobin (the Atlanta type)? The propositus in a Black family has elevated Hb-F and approximately equal amounts of Hb-A and Hb-S. Hematological and chemical studies of the propositus and his family show elevated Hb-F in the father and a sibling and sickle cell trait in the mother and another sibling. This family is believed to have a form of the hereditary persistence of fetal hemoglobin in which beta chains are produced in cis to the determinant.


An individlal with hemoglobins S and deer lodge.


A second case of hemoglobin Grady, repetitive in the middle of the alpha chain.


Asymetric tetramer in a second occurrence of hemoglobin Porto Alegre alpha A2betaAbeta9Ser replaced by Cys. Hemoglobin Porto Alegre is an abnormal human hemoglobin which polymerizes by formation of intermolecular disulfide bonds between the mutant cysteinyl residues at the beta9 position. Biochemical studies of this abnormal hemoglobin from a heterozygous carrier of a second family of carriers indicates that an asymmetric tetramer alphaA2betaAbeta9 Ser replaces Cys is formed after polymerization. Functional studies of the polymer indicate that its oxygen binding properties are unaffected by the polymerization and that its oxygen affinity is somewhat higher than that of normal hemoglobin; it has a slightly reduced heme-heme interaction and a normal Bohr effect.


The significance of certain catastrophic dreams. Four examples of catastrophic dreams in which the dream action progressed to include the total destruction of the dreamer's body image are presented. This feature of total destruction of the body image possesses a special heuristic significance because it is a variance with Freund's clinical experience which helped to shape his view of the factors responsible for the creation of traumatic neurosis. He felt that nothing resembling death can ever have been experienced and therefore he dismissed the idea that the traumatic neurosis could arise a direct result of the fear of death. Each of the dreams revived a real life traumatic event which had caused a registration in the mind of a shattering experience without causing the destruction of the actual body at the same time. When the same traumatic event was revived in the dream the ego functions available at that time were evidently insufficient either to modify the traumatic event or to awaken the dreamer prior to its denouement. The powerless ego of the dreamer seemed to have been derived from the powerless ego of the patient at the traumatic moment in waking life which was carried over into the dream as a part of the representation of the traumatic event. The destruction of the body image in these dreams apparently played a role in the production of symptoms characteristic of the dissociative syndromes. On the morning following the dream three of the patients awakened in a depersonalized state and the fourth in a catatonic state.


Gamma chain variants in Jamaican newborns. 15,661 cord bloods from Jamaican infants were examined for abnormal hemoglobins using alkaline cellulose acetate electrophoresis for the initial screening, supplemented by acid agar gel electrophoresis for samples exhibiting abnormal hemoglobin bands. Of the 16 electrophoretic variants which were detected, six were fully characterized and found to be: four Hb F Port Royal (alpha2 Ggamma2 125 Glu replaced by Ala) and two Hb F Victoria Jubilee (alpha2Agamma2 80 Asp replaced by Tyr). The Hb F Port Royal samples each constituted about one eighth of the total Hb F as did seven additional samples presumed to be Hb F Port Royal. The infants with this variant exhibited no special hematological characteristics or other consistent associations. Both Hb F Victoria Jubilee samples occurred in somewhat lower proportions of the total Hb F compared with Hb F Port Royal and exhibited an apparent increase of free alpha chains in the whole hemolysate. The data available on detectable gamma chain variants suggest that a specific point mutation may occur in either a HbGgamma or a HbAgamma locus.


Altered erythropoiesis and increased hemolysis in hemoglobin M Akita (M Hyde Park beta92 His replaced by Tyr) disease. Hb M Akita disease is a cyanotic hemoglobinopathy found in Akita Prefecture, Japan. The abnormal hemoglobin was found to be the same as Hb M Hyde Park (beta92 His replaced by Tyr) by chemical analysis in 1967. In this disease signs of accelerated hemolysis (serum bilirubin, 2.4 mg/dl; splenomegaly, 2 finger breadths; Hb, 10.7 g/dl; reticulocyte index, 2.7) were noted, but the causes of its slight anemia were revealed to be fairly complex by ferrokinetic study, RBC life-span measurement, and 99mTc myeloscintigram. The anemia in this disease is caused not only by shortened erythrocyte survival (T 1/2 = 11.5 days by 51Cr-tagging method) and sequestration of red cells in the spleen (Spleen: liver ratio = 2.5 approximately 3.0 by 51Cr-surface counting), but also by slow supply of erythrocytes to the peripheral blood from the bone marrow, presumably, related to the existence of unstable Hb M Akita and its derivative (Hb Akita) in the erythroid cells. Both Carrell's isopropanol test and Heinz body formation test were positive. In spite of maximally increased total erythropoiesis (8 times as high as the normal level; M:E ratio = 0.22:1.0), supply of red cells from the bone marrow to the peripheral blood was significantly decreased. The distribution of hematopoietic sites throughout the body was reasonably uniform.


Psychological management of multiple sclerosis. An overview.


Attention and intrinsic rewards in the control of psychophysiologic states. Attention is a process which regulates the information obtained from a stimulus. In this paper I view selective attention as a means of arriving at different psychophysiologic states. Special consideration is given to the self-regulation of enjoyment by selective attention to intrinsically rewarding activities.


Indications for psychotherapy in a psychiatric clinic population. Reliability and validity of evaluations. A half-year survey was made on an in-patient clinic population as to a specific kind of short-term dynamic psychotherapy. The reliability and validity of the evaluations are discussed. It was found that a moderate accordance in evaluations could be found between the evaluators, with a high degree of reliability.


Globin synthesis during erythroid cell maturation in alpha thalassemia. Globin chain synthesis was examined in erythroid cells of increasing maturity, fractionated from bone marrow of two patients with hemoglobin H disease and in one alpha thalassemia 1 heterozygote. In contrast to beta thalassemia where a gradient of alpha/beta chain ratios increasing with erythroid cell maturation is observed, in alpha thalassemia the alpha/beta chain ratio remains constant throughout maturation. This finding suggests that in alpha thalassemia there is no modification of the imbalance in globin chain synthesis either by increased alpha chain production or decreased beta chain synthesis in erythroid precursors. Furthermore, the constant alpha/beta ratio reflects a limited degree of beta chain destruction, indicating that the ability of the excess beta chains to associate into tetramers protects them from proteolytic digestion.


Hb-Alberta or alpha2beta2 (101(G3) Glu replaced by Gly), a new high-oxygen-affinity hemoglobin variant causing erythrocytosis. Hb-Alberta has been found in a 51 year old Caucasian male with erythrocytosis. The substitution in this variant involves the glutamyl residue in position 101(G3) of the beta chain which is replaced by a glycyl residue. Hb-Alberta accounts for about 45% in the heterozygote, and readily forms hybrid tetramers with other hemoglobins. The oxygen affinity of Hb-Alberta is greatly increased, its Bohr effect reduced, and its subunit interaction greatly diminished.


Anxiety and rehabilitation after myocardial infarction. General and specific anxiety, connected with the fact of myocardial infarction (MI), were investigated in 105 patients before and at the end of posthospitalization rehabilitation. Results as regards general anxiety were compared with data of 63 employed men free of coronary disease and with 34 comparable rheumatic patients. The patients with MI, before the comprehensive rehabilitation, compared with both control groups, have had higher levels of general anxiety in a statistically significant way. At the end of rehabilitation there were no significant differences. There was a significant positive correlation between general and specific anxiety, connected with the fact of MI. During the organized comprehensive posthospitalization rehabilitation, we see that there is a statisticallysignificant decrease of general and specific anxiety.


Hemoglobin Dakar.

Hemoglobin Dakar.


Sensory perceptual limitation in schizophrenia. Sensory perception and selective attention capacity of schizophrenic patients have drawn particular interest. Schizophrenic patients show a peculiar deficit in screening and processing of incoming sensory data. Review of the literature suggests a breakdown in the selective-inhibitory function of attention in schizophrenic patients facing multiple sensory modalities. Although disorganization of attention is a focal point in schizophrenic perception, the influence of memory on the perceptual process deserves further investigation. Distracting sensory stimuli particularly of an auditory nature seem to interfere with visual perception and motor performance in these patients. Avoidance of sensory overload and improving selective attention through psychotherapy though of some therapeutic value, requires further exploration. A case of a young schizophrenic patient exposed to distractible environmental stimuli was presented and discussed.


A longitudinal study of some physiological parameters and autogenic training. Physiological parameters were studied over 4.5 months in normal high-school girls. One group frequently practised autogenic training (AT) whereas the other (control) did not. After 4.5 months the physiology of the AT, but not the control group had changed to some extent. The mean increase in finger skin temperature in the final session was significantly greater in the AT group than in the control group, especially in subjects who experienced hand warmth during AT. No significant differenced between groups were apparent for finger blood flow, but within the AT group the girls who experienced hand warmth showed a significantly greater blood flow than those who did not experience hand warmth. The electroencephalogram (EEG) of the AT group showed significantly more 'slow' (delta and theta) and less fast (alpha and beta) activity than at the beginning of the project. Microvibration (MV) of the thumb did not differ significantly in any comparisons. Both in the AT and control group means there were no significant differences between the periods before, during and after AT although significant changes did occur in some individuals of the AT group in the final session. In particular, in 3 of 14 AT subjects respiration rate decreases markedly even though weekly training had not included any breathing exercies. The results suggest that the effects of AT are predominantly long-term, resulting in gradual physiological changes that are maintained to some extent between practice periods.


Anorexia nervosa: a case study.

Anorexia nervosa: a case study. D.R., a single 19-year-old female experiencing anorexia nervosa, was admitted to a mental health center inpatient unit weighing 64 lb, approximately 54 lb underweight, with liver, kidney, and pancreas damage. D.R. was hospitalized for 59 days. Treatment consisted of utilizing a hierarchy of reinforcements in the form of privileges mutually agreed upon between patient and therapist, psychodynamic and supportive psychotherapy, and involvement in the ward milieu therapeutic program. All privileges had to be earned. Access to food was controlled by the staff. For pounds gained privileges were granted, for pounds lost privileges were curtailed. Dynamically, D.R.'s eating behavior was viewed as an unconscious spite and revenge reaction toward her parents as well as an attempt to elicit attention. At the time of discharge D.R. weighed 104.5 lb. Prior to discharge D.R. agreed that if her weight dropped below 100 lb she would return for readmission. Five months later D.R.'s weight stabilized between 102 and 104 lb. Two years later, D.R.'s weight remains at that level. The study cautions against using solely a behavior modification approach in the treatment of anorexia nervosa.


A family systems approach to home dialysis. Dramatic increases in the cost of the end stage renal disease program are producing an emphasis on home dialysis with the patient and his family carrying the responsibility for this treatment. This requires an adjustment of the family's emotional system and role assignment to sustain members through the continued stress of chronic catastrophic illness. We are suggesting a model of intervention in which family members are encouraged to recognize stress caused by one member's illness and to make necessary changes in the family functioning.


Large bowel disorders. I. Illness configuration and life events. Stressful life events preceding disease onset were investigated in a consecutive series of 60 patients with large bowel disorders (ulcerative colitis, irritable bowel syndrome and appendicitis), using Paykel's methodology. Ulcerative colitis and irritable bowel syndrome were frequently preceded by events generally regarded as undesirable and involving losses or exits from the social field, which would be specific of a depressed population, while appendicitis seemed to reflect more generic psychosocial difficulties.


Programmed management of acute cervical cord trauma. Results in ten patients admitted with the diagnosis of complete traumatic quadriplegia and with fracture-dislocation of the cervical spine are reviewed. Emphasis is placed on aggressive emergency surgical treatment of these lesions such as tracheostomy, laminectomy and cord cooling, incorporated into a detailed protocol of overall management.


Use of artificial circulation in resuscitation of drowned dogs. The effectiveness of artificial circulation by the method of Bryukhonenko and his colleagues in the resuscitation of dogs that had died from drowning in fresh- or salt-water was studied. Eight out of ten dogs were revived after freshwater drowning 'death' lasting from 10.5 to 21 min, when a variant of the artificial circulation method, dog donor with a venous pump of the artificial heart, was used. Resuscitated dogs remained alive from 3 to 72 h and died from pulmonary oedema. Artificial circulation appeared to be more effective in resuscitation of dogs drowned in saltwater. Their clinical 'death' lasted up to 31.5 min; clinically signs of pulmonary oedema were not observed in any of them, though some signs of oedema were revealed by histological studies. Of the 42 dogs in this series, all the main functions of the central nervous system were restored in 18 with clinical 'death' for up to 25 min. Resuscitation was performed by one of two methods, either the dog donor plus venous pump of the artificial heart, or the method of Bryukhonenko. The effectiveness of artificial circulation for resuscitation of dogs from drowning was demonstrated.


Plasma cortisol monitoring acute myocardial infarction. A study of the concentration of unconjugated plasma cortisol in nine patients with acute myocardial infarction has been made. The effectiveness of monitoring this factor in assessment of the clinical course and establishing early treatment in this condition is also reported.


An evaluation of basilic vein catheterization. Percutaneous 'blind' catheterization of the basilic vein with a 14 gauge Intramedicut resulted in an intrathoracic placement in 85.4% of cases. The advantages and disadvantages of the technique are discussed. Accurate localization can only be confirmed by a chest radiograph.


Large bowel disorders. II. Psychopathology and alexithymia. Psychopathology and alexithymia were investigated in a consecutive series of 60 patients suffering from large bowel disorders (ulcerative colitis, irritable bowel syndrome and appendicitis). Patients with irritable bowel syndrome reported the highest percentage of psychiatric illness and the lowest alexithymic score. Conversely, patients with ulcerative colitis showed very pronounced alexithymic traits with limited psychopathology. Implications for psychosomatic research and treatment are discussed.


The role of shock in the pathogenesis of fat embolism after trauma. Experimental studies and pathological investigations indicate that intrusion of fat into the circulation is common after trauma. This may not have any effect unless frank hypovolaemia supervenes upon changes in the blood vessels, manifested by a deficient vasomotility in shock. After fat embolism disseminated intravascular coagulopathy may occur as a consequence of the haematological changes and disturbances of capillaries. The morphological appearance of massive post-traumatic fat embolism evolves from the compensatory effect of accumulated synergistic factors that primarily induced the changes. From this point of view fat embolism should be recognized in the additional important role of an epiphenomenon of post-traumatic shock.


Changes in blood viscosity and plasma proteins in myocardial infarction. A clinical study of some biological and biochemical factors was carried out on patients with acute myocardial infarction. It was shown that: (i) the plasma viscosity was highly correlated to the clinical evolution of myocardial infarction; (ii) the variations of plasma viscosity were related to changes in the connection of fibrinogen and globulin; (iii) the highest correlation was between the plasma viscosity and alpha2-globulin concentration. The monitoring of these may be useful in the clinical evaluation of myocardial infarction.


Dysthymia: an atypical protracted depression. A preliminary report. The author reports on 86 cases of protracted disorders - without significant changed consciousness - which he named dysthymia. The clinical manifestations were characterized by peculiar emotional disorders, polymorphous autonomic and vascular shifts. These states occurred in the majority of cases after some somatic diseases in conjunction with other physical or psychological stresses in individuals with anxiety traits and 'neurocirculatory asthenia'. The first phase of the disease was accompanied by anxiety, restlessness, autonomic and vascular paroxysms, anorexia, insomnia and disturbances of other physiological functions. Subsequently dysphoric mood, somatic concerns, pseudoneurotic and neurotic syndromes appeared. The outcome of the disorders was either with slow practical recovery or with a relatively stable personality change in the form of weakened volition, a reduction of energy, and a narrowing of the 'zone of comfort' due to the impairment of homeostatic functions. Often hypochondriasis could develop on the background of such features. Dysthymia is viewed as a special entity which must not be included either in the group of neuroses or in the group of typical organic brain syndromes, or in the group of endogenous psychoses.


Emergency care -- an academic specialty?


Health practice at the technologic/folk interface: witchcraft as a culture-specific diagnosis. "Witchcraft illness" is a widespread belief among many people, even after acculturation to technological concepts of illness etiology. Two cases are presented to show that such beliefs can complicate physical or psychological dysfunctions, or themselves can be the primary origin of physical or psychological dysfunctions. In both instances, witchcraft beliefs take on a dynamic of their own and must be resolved both in terms of the patient's culture as well as the clinician's treatment plan. Considering such phenomena from the vantage point of family systems provides useful insights into etiology as well as amelioration. The latter requires engaging all parties in the health care system-clinician, patient, family, and indigenous health caretakers.


Welfare mothers strike it rich.

Welfare mothers strike it rich.


Possible sequelae of trauma and somatic disorder in early life. All children experience trauma. The age, state of development and constitutional factors will determine whether some children will have a traumatic effect. Trauma occurring before the age of three, at a time when the ego has not developed its synthetic and integrative functions, may be reproduced in later life as an isolated symptom, by selected sensations involved in a sensory imprint or screen sensation of the trauma as a simple recording. After the age of three, under the influence of a more mature ego, excessive traumatic stimuli will be integrated and elaborated in symptom formations as phobias or other conditions and extended as part of the total personality. Recurrence in later life is triggered by events related not only to the original experience, but also to the content of its elaboration. The earlier in life the trauma occurs, the more likely that somatic imprints of primitive physiological symptoms would result as an archaic, biological defense or screen sensations. Recurrent sensory imprints or screens may appear as organic illness or functional somatic symptoms. Diagnostically, a detailed early life history is necessary to uncover the presence of a sensory screen memory of a trauma and so avoid diagnostic medical search for organic causation. Case material illustrating the two groups are presented. Indications for psychoanalysis and for supportive psychotherapy are discussed from our theoretical framework as well as from the literature.


Plasma cortisol in open-heart surgery.

Plasma cortisol in open-heart surgery. In view of disagreements about changes in plasma cortisol, during and after open-heart surgery, a group of patients was studied with both unconjugated plasma cortisol, and anaesthetic, surgical and pharmacological factors that could interfere with the response, being analysed.


The application of competency-based education to consultation-liaison psychiatry: II. intervention knowledge and skills. Although psychological and pharmacological intervention is an important aspect of the treatment of patients seen in consultation on medical and surgical wards, little attention has been directed to the method of training psychiatric residents in these areas. In this paper, the authors continue the application of the competency-based model of training to the problems of clinical intervention. Behavioral objectives are presented as a focus for residency supervision and their application to a clinical situation is illustrated. The objectives are designed to consider the activities of the consulting psychiatrists as he relates to the patient as well as other members of the treatment milieu.


Grief-related facsimile illness.

Grief-related facsimile illness. One aspect of the grief process which is frequently mentioned in the literature on mourning but has not yet received adequate clinical attention is the tendency for the bereaved to assume symptoms and behavior of the deceased. This paper presents evidence that pathologic identificantion 1) is an important clinical syndrome that is frequently misdiagnosed and mistreated, 2) defines a population at high medical and surgical risk, 3) can be diagnosed by history alone, and 4) carries a good prognosis when identified and properly managed. Four of a series of ten clinical cases are presented and discussed. Analysis of the cases reveals a number of common features, including 1) an arrest of the normal grief process; 2) a presentation of symptoms identical or nearly identical to those experienced by the deceased; 3) previous ineffective and inappropriate treatment endeavors; 4) referral for reasons other than a recognition of an abnormal grief state; and 5) improvement or recovery during treatment aimed at facilitating the grief response. Based on a survey of the literature and the clinical material analyzed, the authors conclude that patients who present with psychologic identification with the deceased have a distinct clinical syndrome (grief-related facsimile illness) for which recognition is important to institute proper management. Contrary to the reports in the literature, it frequently presents as other than hypochondriasis. When identified, this syndrome carries a good prognosis.


The application of competency-based education to consultation-liaison psychiatry: I. Data gathering and case formulation. In the first of three papers, the authors present a competency-based model for training in consultation-liasison psychiatry which addresses the issues of how residents are taught to collect and formulate patient data. This model emphasizes the use of behavioral statements to describe the process of how a consultation is done. By comparing the resident's performance with prestated behavioral objectives, a method for residency supervision is offered. The second paper carries this one step further with the application of the model to clinical intervention strategies. The final paper discusses the implications of this approach to some of the issues that surround residency training in this field.


New program saves 150 million dollars in child support collections.


The application of competency-based education to consultation-liaison psychiatry: III. Implications. In this paper the authors consider the implications of a competency-based model of education in relation to issues that affect the training of consultation-liaison psychiatrists. These issues include program design, the integration of consultation-liaison psychiatry to psychiatry in general, and the relationship of consultation-liaison psychiatry to medicine. Training programs in consultation-liaison psychiatry need to respond to the issues that derive from each of these areas. The authors argue that the competency-based model provides a framework which offers guidelines for designing a program that addresses these concerns.


Do nursing homes deserve the heat they've been getting?


Etiology and the prevention of wars. (Preliminary thoughts). There is a suggestion in the previous paper that a way out to convey the overwhelming progress and "heavy" civilization of humanity may be to explore the Space, the Universe, and it, indeeed, results in an excellent job what American and Soviets together are these days endeavoring toward new exploration in Space. Let us see now, is this way out going to give the solution of our problem, hence avoid wars in the world?


Discrepant cortisol values: comparison of radioimmunoassay and competitive protein binding technics. Radioimmunoassays are expected to yield values representing the antigen, i.e., insulin, growth, cortisol, etc. employed in producing the antibody. However, in a recent study of a synthetic ACTH which involved the measurement of cortisol levels (1), we found that above 20gamma%, the radioimmunoassay (RIA) yields cortisol values distinctly above those obtained with the competitive protein binding (CPB) technic. We now suggest a possible explanation for this discrepancy and have calculated a correction factor.


Psychiatry on the prevention of crime.

Psychiatry on the prevention of crime. The main endeavor of Forensic Psychiatry is to find out the causes, to investigate the psychodynamics of crime, hence based on them, to try to prevent or to treat them. In this connection, I will not enter into details today about the position of delinquency into psychodynamics, as they have elsewhere been described; I only would emphasize some cases which take place during the state so-called "hystero-epilepsy" of Charcot.


Inappropriate counter-regulatory hormone levels in insulin treated diabetes. The data herein presented describe, identify, and quantitate interrelationships among blood glucose and serum insulin, growth hormone, cortisol, and glucagon levels of hospitalized insulin-treated diabetic patients. The findings indicate that conventional diet and insulin therapy of diabetes mellitus is almost always accompanied by inappropriate counter-regulation by growth hormone, cortisol, and glucagon. The data are consonant with the hypothesis that a shortage of insulin is only one of the multihormonal defects of diabetes.


Obesity related to the use of psychotropic drugs, considered in its psychodynamic aspect. It is a well known fact that one of the side-effects of the psychotropic drugs is a disturbance of body weight in the form of obesity. We believe this to be a serious side-effect because obesity is often the main reason why the patient discontinues his psychopharmaaceutical therapy, thereby causing a recrudescence of his mental illness. We have proposed that this type of obesity be designated by the diagnostic term "psychopharmacotherapeutic obesity". This paper contains a formulation and discussion of views and concepts related to a consideration of the psychodynamic aspect of the subject. Special emphasis has been given to commenting on the problem of psychopharmacotherapeutic obesity from the standpoint of etiogenesis, psychological effects, and its importance in relation and conjunction with the development and formation of the individuals' psychosomatic identity.


Estrogens and endometrial cancer.

Estrogens and endometrial cancer.


Civil background variables significant to the development of psychiatric disorders during military service. The author served as a military psychiatrist for one year. In this article, he presents material from a personally conducted examination of soldiers with psychiatric disorders. He has also collected material on two control groups of soldiers. He has also processed patient material collected by other military psychiatrists. Both patient groups are compared with the two control groups concerning various civilian background factors. The study shows that the patients differ from the controls regarding a number of negative factors in their civilian background. These factors can be seen as predisposing to the development of psychiatric disorders while in the Military. The author concludes that these factors  ought to be identified at the conscription examination, which is a present in adequate from a psychiatric viewpoint. An effort should be made at conscription to construct a profile of the individual's adaptability. The possibility of the development of a psychiatric disorder could thus be better evaluated.


Obesity related to the use of psychotropic drugs, considered in its organic aspect. The purpose of this brief work is to study and make a general survey of the problem of obesity as related in whatever way, to the use of psychotropic drugs. It is a fact learned through clinical experience and knowledge by clinics and researchers working in the field of psychotropic drugs that patients subjected to extended therapy with such drugs show, in a considerable number of cases, an increase in body weight. We consider that this obesity, the pathogenetic cause of which is attributed to the action of psychotropic drugs, constitutes a serious disadvantageous side-effect of those drugs, since a large number of mental patients discontinue their drug therapy for the reasons that it is responsible for the increase in their body weight. It is a known fact discontinuation of the psychotropic drug treatment generally results in a relapse of their mental disorder.


The psilocybin-induced "state of drunkenness" in normal volunteers and schizophrenics. The effects of the psilocybin, a psychomimetic substance, on mental junctioning were investigated in normal volunteers as well as in schizophrenics. The disturbances induced constitute a psychoneurotoxic syndrome--"a state of drunkenness"--of about four hours duration which develops in three distinct phases. The basic mental symptoms of this syndrome consist of disturbances of the apperception, sensory perception and emotion. A moderate impairment of egofunctioning or reality appraisal and an inability to integrate different mental processes are observed. The psychomotor behavior is mainly harmonized to the prevailing emotional state and to the experiences caused by perceptual alterations, in a lesser degree. These changes, according to our observations, are more severe and more "psychotic-like" in schizophrenics rather than in normals. Psychopathological analysis of these changes proves that the whole syndrome cannot be considered as related to the spontaneously triggered functional psychoses or to the organic ones and, therefore, the term "model-psychosis" according to our opinion, is unsatisfactory.


War Sailor syndrome.

War Sailor syndrome. One third of the Norwegian sailors in the merchant navy, who survived World War II, are today disabled and on invalid pension. The majority suffer from a syndrome which is very similar to that present in the concentration camp survivors. The syndrome falls into two parts, the one consisting of non-neurotic anxiety repeating the terrors of war time, the other being a brain-organic one. This last part has in a few cases been confirmed by neuroradiology and neuropsychology. This is taken as an indicator that prolonged stress, as constant fear of death, may cause brain damage without physical trauma.


Relationship between parental attitude towards the emotionally disturbed child and nocturnal enuresis. In a study of children with nocturnal enuresis a close relationship was found between disturbed family environment and the frequency of enuresis. It will appear that negative parental attitudes in contrast to positive ones, as defined in this paper, are predisposing factors for the appearance of nocturnal enuresis. It is well known that nocturnal enuresis is one of the most serious problems encountered in children. It is estimated that over 25 percent of the children examined in Child Guidance Clinics suffer from nocturnal enuresis. In fact enuresis is considered the most common reason for referral of children to such Clinics. Much has been said about the etiology of nocturnal enuresis, and the organic factor was considered to be of primary importance by physicians of past generations. Spina bifida, local infections, small cyst, adenoids, epilepsy and mental retardation were at times considered as the main causes. Today the organic factor is accepted as an important one in a percentage not exceeding that of five percent. As a psychological psychosomatic phenomenon, nocturnal enuresis is considered to be the result of many interacting factors. One of the psychological factors is known to be the child-parent relationship and the influence of the family environment as a whole. The purpose of this paper is the study of the influence of the family environment on the frequency of nocturnal enuresis regardless of the parents' reactions to the enuresis itself.


Disability, psychosomatic disease, and psychoneurosis. The problem of differential vulnerability. A pattern of cognitive and of affective development characterizing three classes of psychiatric patients is presented: (1) disabled persons, usually unskilled laborers showing a 'somatization reaction', are unable to form abstract categories and, as well, to describe the physiological correlates of 'inner' feelings; (2) psychosomatic patients may show highly developed cognitive skills, although they may not; but they uniformly show a similar inability to 'know' and describe inner feelings; (3) 'neurotic' patients, most dramatically in the phobic category, often show both well-developed cognitive skills and a high degree of sensitivity to, and ability to describe, the symptom complex of anxiety in physiologically relevant forms, with maintenance of meaningful relations with supportive (often 'overprotectively' supportive) family members. These three different states can be diagrammed as follows: (1) -, -; (2) +/-, -; (3) +, +. The suggestion appears that these differences have to do with vulnerability, and that there may be in the general population three separable populations at risk for the development of these three categories of psychiatric disorder. The vulnerability so identified seems to be inversely proportional to 'suitability for interpretative psychotherapy'.


Functional cerebral asymmetry and performance. I. Reaction time to words and dot patterns as a function of EEG alpha asymmetry. Alpha activity in left and right hemispheres was recorded while subjects performed in verbal and nonverbal target detection/reaction time tasks. Alpha in the right hemisphere was paradoxically enhanced during the nonverbal task, but RT varied as a function of differential hemispheric arousal in the expected manner--e.g., RT to words was fastest in the performance set showing greatest relative left hemisphere arousal.


Functional cerebral asymmetry and performance II. Individual differences in reaction time to word and pattern stimuli triggered by asymmetric alpha bursts. The difference in mean square values of EEG alpha in left and right hemispheres recorded from parietal scalp regions of 5 female and 6 male human Ss was used to trigger 50 msec presentations of words or random dot patterns, and reaction times to correctly detected target stimuli were obtained. In 9 of 11 Ss the effect of left and right triggering was opposite for word and pattern stimuli, although in only 4 Ss were results consistent with a simple interpretation of alpha as an "idling" rhythm. The results support the hypothesis of complementary hempheric specialization and indicate that overt performance depends on the state of functional cerebral asymmetry.


Gestosis and the psychosomatic phenomenon--an empirical investigation. Patients suffering from psychosomatic diseases in the strict sense of the term (asthma, ulcers, colitis etc.) have characteristic object relations which we call the 'relation blanche'. The present investigation aims at finding out whether similar features can be observed in patients suffering from early and late gestosis. The results indicate that there is a definite connection between gestosis and the group of strictly psychosomatic diseases, thus confirming our hypothesis that gestosis does not primarily represent a neurotic conflict situation nor a psychotic breakdown.


Psychotherapy and sociology: flirtation, marriage or divorce? Psychotherapy and sociology are themselves products of mixed marriages; each experiences problems of identity and their children face problems of legitimacy. This paper considers the relevance of some sociological perspectives to the psychotherapeutic process, using the following analogies; (1) Flirtation: Why the attraction? 'going steady' or 'femme fatale'? (2) Marriage: Mutual enrichment, cross-fertilisation and new life? Examples of shared perspectives in the work of E. Becker, Erikson, Goffman etc. Influence of psychosocial contexts on psychotherapeutic processes. (3) Divorce: Too little shared life or too much destructive criticism? If the world within man and the world between men are interrelated, psychotherapy and sociology--although at times uneasy bedfellows--have much to give each other.


Visual and auditory cognitive processing affected by epilepsy. Neuropsychological studies on epileptic patients may be expected to reveal specific cognitive dysfunction even in patients with normal general intellectual ability. Difficulties in cognitive processing by visual-spatial and auditory-verbal modes are indicated by this investigation employing the Wisconsin Card Sorting Test and the Token Test, with epileptics of normal intelligence. Impairment in capacity for sustained, focused attention significantly affects performance of epileptic patients on these clinical measures, and others as well which require vigilance and attention and sensory-perceptual discrimination.


"Short and long-term therapies in psychosomatic disorders". Narcoanalysis (narcosynthesis) as well as psychoanalytically oriented psychotherapy (psychoanalytic psychotherapy) are both, in my opinion, practical and useful short-term methods of therapy in psychosomatic disorders. Psychoanalytic psychoterapy may also be used as an alternative to narcoanalysis when the latter method decisively fails the therapist. In selecting candidates for psychotherapy in psychosomatic practice, 3 essential factors should be taken into consideration, viz. the time of onset of the illness, the patient's personality structure and his intellectual capacities.


A context study of psychological conditions prior to shifts in blood pressure. Shifts in intra-arterially registered blood pressure during an initial interview were studied in 4 young patients with essential hypertension by means of the Symptom Context Method. The relationships found between both formal variables and thematic categories of speech anteceding blood pressure shifts were in terms of patient and interviewer. All patients showed an increased rate of speech before blood pressure elevations, and in 3 of them the thematic content of 'personal failing, personal failure', 'loss of status of being useful and needed', and 'failure of others to meet the standards of the patient' was more often present before pressure elevations than decreases.


Psychological and physiopathological study on coronary patients. In this paper the AA have tried to define the relationship between psychopathological characteristics or symptoms and angina attacks in coronary patients. The research plan was agreed upon and carried out as a collaborative program between psychiatrists and internists with the goal of reaching a more comprehensive approach to the psychosomatic patient. In 20 patients suffering from nocturnal angina attacks the polygraphic sleep recording was performed; 10 of them received psychodiagnostic examination (MMPI). In 8 cases during sleep recordings hemodynamic monitoring was also performed. The MMPI data were compared with 82 other individuals who had myocardial infarction (56 ss) and diurnal angina (26 ss) and 34 control subjects without cardiac disease. The results show that the sleep patterns were strongly affected and the most relevant alterations were recorded during the nights with ischemic episodes. No significant correlations were found between ischemic episodes and sleep stages. In no instance did the hemodynamic monitoring show an increase in the parameters related to myocardial oxygen consumption. The psychological data showed that the most severe symptomatology was observed in the nocturnal angina patients where the disease seems to be mostly related to a functional pathogenic mechanism.


Management of pain through cerebral activation. An experimental analogue of alexithymia. The present experiment was designed to explore the relationship between pain, language and cerebral functioning in normal subjects, as an analogue to alexithymia. Left hemisphere cerebral activation, as measured by an EEG-alpha ratio score, was found to be associated with a reported increase in painful sensation during painful stimulation. Right hemisphere activation was found to be associated with a decrease in reported pain. The results were interpreted in terms of the mobilization of fantasy processes, following experimental instructions, which seem to be mediated by right hemisphere activation. Uninstructed subjects, lacking a stable visualization, utilize a left-hemisphere, verbal mode to cope with the pain. It is suggested that left-hemisphere mobilization, and a lack of right-hemisphere processing of painful stimulation may be in part responsible for the alexithymic patients' psychosomatic symptoms.


Borderline hypertensives volunteering for follow-up and biofeedback. A preliminary study: locus of control characteristics. We compared the locus of control scores of the following groups: (1) 19 male borderline hypertensives volunteering for biofeedback treatment; (2) 100 consecutive males who were screened for hypertension; (3) 30 male cancer patients receiving radiation therapy, and (4) the normative data from college students. The biofeedback volunteer group was significantly more internal in locus of control as compared to all other groups. The locus of control of the borderline hypertensives within the screened population did not differ from the normotensives, but the screened population as a whole had a relatively internal locus of control. Our findings imply that the 'internals' may be more attracted to self-control treatments like biofeedback, and data generated from this particular population may have limited generalizability, especially in regard to 'externals'.


Borderlines: problems of self and object separation. The borderline has deficiencies in the capacity to maintain stable self and object representations and in establishing 'emotional separateness' from others. In order to create and maintain a 'propitious treatment situation' and a 'therapeutic alliance' the therapist must work with unusual sensitivity and repetitiveness on the ground rules of the therapeutic environment. Explicit clarifications of the therapist's usual constructive attitudes, as a caring, responsive, neutral and real person must be continuously emphasized. The intense psychotic transference potential that leads to therapeutic complications and disruptions can be worked through, if recognized early, through countertransference clues, acceptance of positive aspects of the countertransference and technical moves that enhance the patient's capacity for individuation and separation, all this within the framework of a structured and consistent therapeutic situation. These assertions are illustrated by specific instances from treatment processes.


A therapeutic approach and objective test in the treatment of tremor. Medical treatment of tremor is deceptive. The biochemical disturbance causing its appearance is not known, so that no specific treatment can be applied. Many substances have been proposed for their antitremulant properties, but clinical results must be interpreted with caution as tremor is a labile symptom which is under many influences. The authors have analysed the clinical effect of an interesting antitremulant drug and have reported an original method for measuring tremor.


Field trial of compact travel dialysis system. To increase mobility for home hemodialysis patients, a portable, light weight hemodialysis system has been bench and field tested. The combination of a 21 L dialysate reservoir and small, high speed blood and dialysate pumps has permitted the entire system to be contained in a twenty two pound, 22 X 13 X 6 inch aluminum suitcase. Initial evaluation in hospitalized patients has shown the system to be safe and efficient. Acceptable clearances of creatinine and urea are maintained throughout a five hour dialysis by changing the bath at 120 and 210 minutes. Successful application of the system in travel by 3 patients, who perfomed a total of 12 dialyses in their hotel rooms while on vacation, indicates the broad potential of the new system.


RF lesion generation.

RF lesion generation. Although the technique of RF lesion generation is a well-established medical technique, most professionals using it do not understand the basic principles of electronics by which the phenomenon occurs. A review of this with special attention to the 'indifferent' or 'dispersive' electrode would lead to better practice and less adverse effects, such as patient skin burns.


No specific thalamic influence on cell composition, sugar or electrolytes of peripheral blood. Cellular components, blood sugar, and serum electrolyte concentrations of chloride, sodium and potassium were analyzed serially in 20 patients who underwent either stereotactic thalamotomy, frontal internal capsulotomy or subcaudate tractotomy. No significant changes were seen during the interventions either after electrical stimulation or coagulation of the target area, but 3 h after the operation the neutrophile granulocyte count was significantly raised. This reaction reached a peak by the morning of the first posoperative day. Other cellular elements, blood sugar, and serum electrolytes remained unchanged. We believe that the leukocytosis is not a specific effect of the thalamic lesions, but a nonspecific stress reaction, similar to that seen after air encephalography.


Psychometric investigation in 48 Dutch patients suffering from psoriasis. 48 psoriasis were compared with patients suffering from a variety of psychosomatic diseases, with regard to neuroticism, extraversion and self-defensive attitude. In addition, a Social Anxiety Scale was administered to the psoriasis patients to evaluate the patient's concern of his appearance in social situations. Finally, some psychometric data, which differentiated between the males and the females of the psoriasis group, are discussed.


Theoretical considerations on molecular transport in dialysis and sorbent therapy for uremia. The technology of uremic blood purification has grown rapidly over the past decade and has provided the clinician with a wide range of therapeutic options. These options involve mass transfer processes which may be primarily due to diffusion or convection, or a combination of both mechanisms. However, regardless of the mechanism of molecular transport, evaluation of the clinical utility of these therapies requires studies which provide sufficient data to solve the appropriate rate equations and to close mass balances. Data from the recent hemodialysis, peritoneal dialysis and sorbent literature are analyzed to show the magnitude of variability in both patient and therapy-related mass balance paramters for urea nitrogen (U) and middle molecules (MM) and to provide unambiguous comparisons for some of these therapies. A theoretical model is developed to describe sorbent-mediated gut elimination of solute as a first-order clearance limited by sorbent saturation. The model is used to analyze data in the literature on AL (OH)3 facilitated gut clearance of phosphate and indicates a gut P clearance of approximately 20 ml/min with maximum removal of approximately 800 mg P/24 hrs. Similar analysis of oxystarch indicated a gut U clearance of 2.5 ml/min and maximum removal of 1.5 gm/24 hrs.


A 4-year follow-up study of in-patient psychosomatic patients. The subjects of the inquiry were 13 psychosomatic patients who had all undergone psychotherapy in the special research unit of the University Clinic for Psychosomatics in Giessen (FRG) in 1971. Data collection took place at the beginning (time a) and end (time b) of in-patient treatment, and then again 4 years later (time c). The same test battery was administered each time. The results indicate that a significant change in the patients' self-image came about during in-patient treatment and the catamnesis carried out 4 years later attests to the stability of this development. The question of whether this change reflects the patient's adjustment to the ideals of his therapist--conformity with the 'norm'--or can be interpreted as a criterium for true ego development in the sense of an expansion of his psychic possibilities, is discussed.


Area in the rat brain producing rhythmical slow activity after chemical stimulation. Serotonin, carbamylcholine, norephinephrine, and various control substances were implanted stereotaxically into various areas of the rat brain, and the effects of the compounds in altering the hippocampal rhythmical slow activity (RSA) were noted. Both carbamylcholine and serotonin implanted into the tip of the diagonal bands of Broca were observed to produce a regular rhythm of 7 Hz in both dorsal and ventral hippocampal recording sites. Carbamylcholine implanted into the medial parolfactory area consistently elicited RSA only in the ventral hippocampus recording area, while carbamylcholine implanted into the lower limb of the diagonal bands elicited the rhythm only in dorsal hippocampal recording sites. In rats in which the rhythm was elicited by serotonin, no effect was seen upon further implantation of carbamylcholine, whereas the converse was not true. These results are interpreted as suggesting a serotonergic influence upon hippocampal RSA separate from the usual cholinergic system which seemed to be inhibitory in nature.


Several clinical aspects of thalamic pulvinotomy. Several clinical aspects of thalamic pulvinotomy were investigated. Influence of electrical stimulation of pulvinar on consciousness, speech, memory, evoked response, emotion, intelligence, character, ophthalmic and auditory examinations were studied during operation and compared between pre-, post, and during operation.


Vascular lesions of the thalamus on the dominant and nondominant side. A clinicopathological study was done on 87 subjects with VPL lesions due to vascular pathology, with special reference to the difference of clinical manifestations between the right and left sides. Thalamic pain was far more common in VPL lesions on the right side. The responsible lesions for thalamic pain were observed in lesions of VPL and VPL extending to the internal capsule, while in the lesions of the VPL extending to the centrum medianum, central pain was rare. 2 cases with aphasia due to thalamic hemorrhage were found in this series, both in the dominant hemisphere. It is suggested that the thalamus in the dominant hemisphere may be related to speech and in the nondominant to a central pain mechanism.


Cold carbon apparatus for hemodialysis.

Cold carbon apparatus for hemodialysis. A prototype of artificial kidney with regeneration of the dialysis fluid in active carbon at low temperature is presented. The data obtained through a series of simulated dialysis show that carbon adsorbs, besides creatinine and other compounds, urea in satisfactory quantities. Furthermore, the possibility of completely regenerating carbon with tap water washing makes the routine use of an artificial kidney based on a cold operating carbon depurator extremely practical.


Sorbent regeneration of peritoneal dialysate: an approach to ambulatory dialysis. Sorbent regeneration of peritoneal dialysate has been shown to be feasible in experimental and preliminary clinical studies and provides a realistic basis for the optimization of dialysis therapy and the potential development of an ambulatory dialysis system. Peritoneal dialysis efficiency can be significantly enhanced by continuous dialysate flow techniques and the mass transfer of uremic solutes can be theoretically augmented by the increased dialysis time made possible by a wearable design. Further optimization of end stage renal failure therapy may be achieved by the combined use of various methods for blood purification.


Current nursing practice in dialysis care: a summary. The provision of comprehensive care to patients requiring maintenance hemodialysis has developed into a complex multidisciplinary effort involving nurses at all levels. Nephrology nursing has evolved over 15 years into a model of so-called "expanded practice," i.e., one in which technical expertise and broad scientific and professional education are necessary as well as significant commitment to quality of care. This practice includes unusual responsibility for management of many aspects of patient care. Described in this paper are the specific responsibilities expected of nurses in hemodialysis, including the response to clinical problems during dialysis. Also reviewed are the more independent contributions of nurses to home and self-care dialysis. An outline of recommended educational content for nephrology nurses is included.


Long-term follow-up results of bilateral thalamotomy for parkinsonism. 27 patients who underwent bilateral thalamotomy for parkinsonism over the past 10 years have been clinically evaluated. Mean follow-up period was 6.2 years after second surgery. In these cases, 8 returned to full social life without any medication, 4 were capable of social life with medical treatment, 6 were self-sufficient and 3 were semi-self-sufficient in ADL, respectively. Therapeutic drug doses were reduced in all cases. L-Dopa-induced dyskinesia was not observed after second surgery. Speech disturbance, which was not severe, was recognized in 12 cases as a complication.


Why a new journal, why GENE?

Why a new journal, why GENE?


Correlation between the neural noise in the thalamus after cerebrovascular disease and computerized tomography. A case report. The case is presented of a 45-year-old man who suffered from a sudden attack of unconsciousness with right hemiplegia and later developed a spastic hemiparesis accompanied by involuntary movement of the right upper limb. CT scan revealed an old putaminal hemorrhage and almost intact thalamus, but neural noise recordings during the stereotactic thalamotomy of this case showed marked decrease of the neural activity in the thalamus suggesting some functional changes.


Electrophysiologic principles of radiofrequency lesion making. Understanding of the electrophysiologic principles of radiofrequency lesion making is necessary to ensure reliable results in surgical procedures using this technique. A radiofrequency lesion is produced by tissue electrocoagulation. Its method of formation and factors affecting heat generation and loss are discussed. Guidelines for making radiofrequency lesions, based on electrophysiologic principles are outlined.


Analysis of tremulous movements after thalamotomy correlated to intrathalamic therapeutic lesions. Residual tremulous movements after thalamotomy were examined using an accelerometer and EMG. Various types of tremor-provoking procedures were performed and the tremulous movements were classified according to the pattern of modificiation by these procedures. Four types of postoperative tremulous movements were noted, and a correlation was made to the intrathalamic therapeutic lesions.


Generation in vitro of deletions in the broad host range plasmid RK2 using phage Mu insertions and a restriction endonuclease. Several non-lethal deletions of the broad host range plasmid RK2 (molecular weight of 37.6 . 10(6) have been produced in vitro. The method employed relied on the single HindIII restriction nuclease site in RK2 and the ability of phage Mu to insert and thereby add new HindIII restriction sites at various positions in the plasmid. The deleted plasmids have in each case lost kanamycin (Km) resistance, and in two cases are defective in self-transmissibility. The method used to reduce the size of the RK2 plasmid also results in the cloning of each of the two ends of the Mu phage DNA on the plasmid derivatives.


The proportion of revertant and mutant phage in a growing population, as a function of mutation and growth rate.


Influence of subcortical stimulation on amygdaloid kindled cats. Amygdaloid kindling seizures with threshold stimulation was modified by electrical stimulation of certain subcortical structures such as the VL, the CGM and the MRF. Low frequency stimulations of the VL and the CGM (10 Hz) were effective for seizure inhibition. On the contrary, high frequency stimulation of the MRF (300 Hz) tended to facilitate the generalization of the seizure.


The thalamus in the motor system.

The thalamus in the motor system. The ventrolateral (VL) and anterior (VA) are the main thalamic relay for cerebellar and pallidal efferents going to the motor cortex. Four aspects of the function of these nuclei are briefly considered. (1) It is well known that these thalamic structures are not a simple relay on the way to the motor cortex, but that they have a gating function for the cerebellar afferents. The gating mechanism is active during slow-wave sleep, with deafferentation and with the use of various anesthetics. Possibly, it might play a role in the central organization of movement. (2) The organization at the unitary level of the projections between VL and motor cortex is examined and their role in the command of motor synergies through the motor cortex is strongly suggested. (3). It appears that unitary activity of VL neurons is not only related to movement but also to postural changes associated with movement. (4) The sensory input to VL nucleus is briefly analyzed. The inefficacy of exteroceptive stimulation in awake animals, in contrast with the effect of the same stimulation in anesthetized preparations, is discussed.


In vitro site-directed mutagenesis: generation and properties of an infectious extracistronic mutant of bacteriophage Qbeta. An infectious extracistronic mutant of phage Qbeta has been prepared by site-directed mutagenesis. Qbeta RNA minus strands containing the mutagenic base analog N4-hydroxy-CMP instead of UMP at position 39 from the 5' end were synthesized in vitro and used as template for Qbeta replicase to synthesize one generation of plus strands. E. coli spheroplasts were infected with the newly synthesized plus strands and phage recovered from single plaques. RNA sequence analysis revealed that four out of the eighteen phage clones analyzed contained RNA with an A leads to G transition at position 40 from the 3' end (which corresponds to position 39 of the minus strand). Thus, the viability of phage Qbeta does not depend on a unique nucleotide sequence in the 3'-extracistronic RNA segment. Upon in vivo propagation of mutant 40, spontaneous true revertants arose with high frequency and overgrew the parental clone within about 10 passages, indicating a selective disadvantage of the extracistronic mutant. Replication of mixtures of wild type and mutant RNA in vitro resulted in a decrease of the proportion of mutated RNA in the progeny plus strands. The fact that Qbeta RNA containing an A leads to G transition in nucleotide--40 of Qbeta RNA is less efficiently replicated in vitro may explain the selective disadvantage of the mutant phage in vivo. The preparation of an infectious mutated RNA by site-directed mutagenesis shows that the method is suitable to produce specific nucleotide exchanges without impairing the biological competence of the RNA.


Distribution of evoked potentials on stimulation of the human pulvinar. The distribution of the evoked cortical potentials recorded during stereotactic pulvinectomy is analyzed. The evoked cortical potential shows maximal amplitude in the precentral area, with decreasing amplitude in the parietal and anterior temporal area, and minimal amplitude in the occipital area. The pulvinar has been histologically considered to have dense connections with the parietal lobe and no connection with the frontal lobe. However, our results suggest that the pulvinar has a dense functional connection with the frontal cortex, through which the pulvinar plays a role in motor function.


Role of computerized transverse axial tomography on stereotactic surgery of the diencephalon. A preliminary report of 67 cases. 67 cases of various functional disorders of the diencephalon were examined by EMI scanner. The patients were composed of 38 cases of parkinsonism, 7 cases of thalamic syndrome, 6 cases of choreoathetoid movement, 2 cases of dystonia, 11 cases of involuntary movement of unknown etiology and 1 case of torticollis, tic, and ballismus, respectively. In parkinsonism, 79% showed diffuse cerebral atrophy, 5% had focal low density in the substantia nigra and the thalamus, whereas 16% remained normal. Pre- and postoperative assessment with CT scan was briefly discussed with reference to stereotactic surgery of the diencephalon.


Physiologically defined VIM nucleus. Its special reference to control of tremor. In the course of stereotactic surgery for some 100 parkinsonian patients, correlative study of recording and stimulation has been done in and around the thalamic nucleus ventralis intermedius (VIM) under local anesthesia. The VIM nucleus is roughly identified either by the increase of neural noise level or radiological measurement. More accurately, in the thus identified VIM, sensory neurons related to kinesthetic sense of the contralateral extremity were found in about half of the cases. Electrical stimulation of this point at threshold intensity produced paresthesia on the contralateral area around its receptive field. With increased stimulus intensity, increment of grouping discharge in EMG of that part was pertinent in the majority of cases. A small localized lesion at such a thalamic point was shown to be quite effective for alleviation of tremor without any neurological, especially sensory, deficit.


Treatment of rheumatic fever and rheumatic carditis.


Diuretic drugs.

Diuretic drugs.


Experience in a district general hospital using a low dose insulin regimen for diabetic coma.


Emotional slow negative potential shift (CNV) in the thalamus. In order to know the functional relationship between CNV recorded at the vertex and activity of the thalamic nucleus, the CNV at the vertex and the intrathalamic slow potentials responding to an S1-S2-R paradigm were recorded during thalamotomy under local anesthesia. It might be concluded that the activity of the medial thalamus and medial parts of the subthalamic area not only generate slow potential shifts corresponding to S1-S2-R, but also play an important role in controlling the CNV at the vertex.


A general method for inserting specific DNA sequences into cloning vehicles. A general method has been developed to introduce any double-stranded DNA molecule into cloning vehicles at different restriction endonuclease sites. In this method a chemically synthesized decadeoxyribonucleotide duplex, containing a specific restriction endonuclease sequence, is joinlex DNA is cut by the same restriction endonuclease to generate the cohesive ends. It is then inserted into the restriction endonuclease cleavage site of the cloning vehicle. To demonstrate the feasibility of this new method, we have inserted separately the synthetic lac operator DNA at the Bam I and HindIII cleavage sites of the plasmid pMB9 DNA.


Readiness potentials recorded from the scalp and depth leads. Readiness potentials on voluntary hand movements were recorded from the scalp (C3, C4), premotor cortex, subcortical white matter and VL nucleus of the thalamus. Subjects were healthy right-handed men and patients with involuntary movement disorders. We obtained a slow negative shift of brain electrical potentials from the scalp and cortex preceding voluntary hand movements. The mean time interval between the onset of the readiness potential and the onset of motor activity (mean T) was 0.8 sec on right hand movements and 1.0 sec on left hand movements in healthy men. In cases with parkinsonism, the mean T value was 1.4 sec in patients with akinesia, 1.1 sec in those without akinesia. The amplitude of readiness potentials was higher in the scalp contralateral to the hand movement. The readiness potentials recorded from the VL nucleus and white matter were reversed in polarity from those of scalp and cortex. Simultaneous recordings from cortex and VL nucleus showed early onset of readiness potentials from the cortex by approximately 0.1 sec compared with the VL nucleus.


Some physiological aspects of the basal ganglia. Excitation of the neurons of the globus pallidus by the brain stem structures. The caudate efferent fibers to the globus pallidus are inhibitory in nature. The pallidothalamic fibers are also inhibitory, exerting monosynaptic IPSPs on the thalamic cells located anteroventrally to the ventrolateral nucleus. Therefore, these two inhibitory neuronal circuits make a double inhibitory chain. To operate the inhibitory circuit, excitatory input to the pallidum is necessary. Stimulation of the ipsilateral brain stem including lemniscus medialis, mesencephalic reticular formation and some other structures, produces short latency excitation of the pallidal cells.


Digitalis--indications, contraindications and nonindications.


Electrolytes in cardiology.

Electrolytes in cardiology.


The clinical development of disopyramide.


Postural dependence of reaction time in normal subjects and patients with focal brain lesions. EMG reaction times (EMG-RTs) of triceps brachii muscle of normal subjects and patients with focal brain lesions were measured at two different positions of the shoulder joint. The difference of EMG-RTs between the two positions was smaller in patients with VL-thalamotomy, cerebellar or frontal premotor lesions than in normal subjects and patients with hemiplegia. It is assumed that cerebellum, VL-nucleus and the premotor area are related to the proprioceptive control of RTs.


Management of digitalis and other drug induced arrhythmias.


Medical management of congenital cyanotic heart disease.


Management of congestive cardiac failure in infants and children.


Cardiac arrhythmias in infants and children.


Management of chronic cor-pulmonale.

Management of chronic cor-pulmonale.


Drug combination in cardiac practice.

Drug combination in cardiac practice.


Cancer patterns of black gold miners in South Africa.


Fat embolism.

Fat embolism.


Subdural haematoma.

Subdural haematoma.


Some thoughts on the management of limb fractures and their complications.


Indications for operative treatment of fractures of long bones.


Iron deficiency - anaemia.

Iron deficiency - anaemia.


Chronic obstructive airways disease.

Chronic obstructive airways disease.


Priapism.

Priapism.


Hyperextension injuries at the wrist (two cases).


Specific affinity fractionation of lymphocytes using glass or plastic bead columns. This paper describes column fractionation techniques for separating different lymphocyte subpopulations. For this purpose columns can be coupled with antigen, specific antibodies to membrane determinants on lymphocytes, or immune complexes or aggregated immunoglobulins, which interact with Fc receptors.


Fractionation of immunocompetent cells with different physical properties. This paper deals with recent developments in the fractionation of immunocompetent cells with different physical properties, using preparative free flow cell electrophoresis, fractionation of cells according to their size and density.


Purification, fractionation and assay of antibody-dependent lymphocytic effector cells (K cells) in human blood. In this article we present methods for the purification and fractionation of human blood lymphocytes, which have been used in our laboratory to characterize antibody-dependent cytotoxic effector cells (K cells). The assay system consists of highly purified lymphocytes, 51Cr-labelled chicken erythrocytes (Ec) and IgG rabbit anti-Ec in high dilutions. Various ways of comparing K-cell potentials of different lymphocyte preparations in this system are discussed. When purified lymphocytes are partially depleted (60-85% depletion) of cells forming rosettes with sheep erythrocytes (E+ cells), the K-cell activity of the depleted fraction is increased, indicating the the majority of the E+ cells are inactive in this assay. Depletion of EAC-rosette-forming cells shows that most or all K cells have complement receptors. For depletion of B cells, the lymphocytes may be passed through glass bead columns, charg ed with F(ab')2 fragments of human IgG and F(ab')2 fragments of rabbit antibodies to the F(ab')2 part of human IgG. These columns give high yields of B-cell depleted fractions. These preparations are rich in E+ cells and contain approximately 80% of the Fc-receptor lymphocytes which form rosettes with bovine erythrocytes, coated with IgG antibodies. Their K-cell activity is unchanged or slightly elevated, indicating the mature B cells, i.e. SIg+ cells, have little or no K-cell activity. In contrast, passage of the lymphocytes through immune complex columns (ovalbumin/anti-ovalbumin) leads to approximately 70% depletion of Fc receptor-bearing cells, while most of the B cells (SIg+ cells) pass through the columns. The relative frequency of E+ cells in the passed fraction frequently shows a slight reduction. These preaparations have a very low K-cell activity, indicating that K cells are lymphocytes with Fc receptors of relatively strong avidity.


Isolation of lymphocytes, granulocytes and macrophages. This paper presents the standard procedure for isolating lymphocytes and granulocytes from blood, using the Isopaque-Ficoll technique. A procedure for isolating granulocytes and macrophages from peritoneal fluid is also described.


Acute gastroenteritis in infants: (analysis of 483 cases treated in an infant's ward).


Thymic dysplasia with normal immunoglobulins (the Nezelof syndrome). (A case report).


Anemia in rickets due to vitamin D deficiency.


Fatal intrahepatic cholestasis.

Fatal intrahepatic cholestasis.


Double orifice mitral valve associated with ostium primum atrial septal defect: (case report).


The site of modification of hemoglobin A by bromotrifluoroacetone?


Increased proteolytic susceptibility of aldolase induced by actin binding.


An investigation of relative subunit motility in human luteinizing hormone molecules using depolarization of fluorescence.


Characterization of double-stranded RNA from HeLa cell mitochondria.


Amino-terminal sequences of the anti-tumor lectin ricin A- and B-chains.


Differentiation of factor C-LHIH and the synthetic contraceptive polypeptide, H-Thr-Pro-Arg-Lys-OH.


Intermediates of the first round of lambda DNA replication are preferentially found in a rapidly sedimenting complex.


A new ferricyanide reactive site in soluble succinate dehydrogenase.


Hydrogenated polyprenol phosphates - exogenous lipid acceptors of glucose from UDP glucose in rat liver microsomes.


Alteration of human lymphocyte triosephosphate isomerase isozymes during blastogenesis.


Anaerobic degradation of the progesterone side chain: a possible new pathway for the biosynthesis of androgen hormones.


Purification of a 3S cytosol androgen receptor from rat prostate that stimulates DNA-dependent RNA synthesis in vitro.


Metabolism of benzo[a]pyrene. III. An evaluation of the fluorescence assay.


On the conformation of some substituted adenosine 5'-monophosphates.


Effects of low temperatures on formation and conservation of high energy state (Xe) appearing in spinach chloroplasts during the light step of the two-stage phosphorylation: I. - Formation of Xe below 0 degrees C II. - Conservation of Xe between- 30 degrees C and -196 degrees C.


Effect of cobalt on microsomal cytochrome P-450: differences between liver and intestinal mucosa.


New properties of the DNA polymerase-beta isolated from non stimulated normal human lymphocytes.


Heritable reciprocal translocations and sperm abnormalities in the F1-offspring of male mice treated with triethylenemelamine (TEM).


Evidence for a 40,000 dalton species of plastocyanin as the active component.


The management of amblyopia without occlusion.


The optical quality of the monochromatic retinal image as a function of focus. Changes in retinal image quality with focus for an aberration-free eye with a 5-mm pupil are discussed in terms of both geometrical and physical optics. Further modulation transfer function curves illustrate the effect of spherical aberration. These theoretical results are compared with analogous experimental data obtained at different wavelengths with quasi-monochromatic illumination, using a double-pass photo-electric, scanning instrument. The comparison shows that the approximations of geometrical optics predict ocular performance quite well, provided that the errors of focus are reasonably large (greater than or equal to 0.5 DS for a 5-mm entrance pupil). Possible sources of error in the experimental measurements are indicated.


The possible influence of contact lenses on myopia.


Drug metabolism as a mutation--drug metabolism in mutation.


The specific blocking of humoral immune cytolysis mediated by anti-tumor antibodies degraded by lysosomal enzymes of tumor origin. The IgG fraction from rabbit antisera against a mouse plasmacytoma (RaPCT-IgG) was incubated, under acidic conditions, with lysosomal extracts (LE)  derived from the corresponding tumors. The LE-treated IgG demonstrated a significant decrease in its complement-dependent cytotoxic potential when compared to RaPCT-IgG incubated without LE under the same conditions (control IgG). Ammonium sulfate (AS) precipitation of the control IgG and the LE-treated IgG preparations at 40% saturation of AS revealed that some of the IgG lost its precipitability at this AS concentration after LE treatment, but could be precipitated at 60% or 70% saturation. The LE-treated IgG and control IgG fractions that precipitated by 40% saturated AS showed similar gel filtration profiles. The LE-treated IgG fraction precipitating at 70% saturation of AS (but not at 40%) showed a different gel filtration profile. This fraction was separated into several subfractions, some with an apparent lower molecular weight. Some of these subfractions which still contained antigenic IgG lacked any expression of antigenic Fc, and were not cytotoxic to tumor cells. They could, however, rebind to tumor cells and block the complement-dependent cytotoxic activity of native RaPCT-IgG. Lysosomal enzymes of tumor origin seem, therefore, to convert cytotoxic anti-tumor antibodies into molecules devoid of Fc but still retaining their antigen binding activity. Such an activity, if occurring in vivo might enhance tumor growth.


The double-contrast enema: myths and misconceptions. The role of the double-contrast enema (DCE) remains contraversial since no controlled comparison between the barium enema (BE) and the DCE has been performed. As a result of our experience with routine use of the DCE, we believe that it is the most sensitive technique for the detection of polypoid, annular, and inflammatory lesions in the colon. There are many commonly held myths and misconceptions regarding the DCE and these are discussed and refuted. The advantages of the DCE over the BE are discussed and illustrated.


Double-contrast examination of the esophagus. A simple technique for double-contrast esophagography is described. The technique involves successive swallows of an excellent coating barium mixture and water to create the double contrast effect. Clinical and radiologic situations in which double contrast esophagography have proven helpful include: (a) the detection of small esophageal tumors; (b) delineation of the morphologic features of neoplastic and inflammatory disease; and (c) assessment of the total vertical extent of esophageal disease. Accurate and/or confident diagnosis is aided considerably with double-contrast esophagography.


The esophageal and small-bowel manifestations of progressive systemic sclerosis. A pathophysiologic explanation of the roentgenographic signs. Goetz suggested progressive systemic sclerosis as replacement for sclerderma because of recognized systemic visceral involvement. Gastrointestinal manifestations are caused by atrophy and fibrous replacement of the submucosa and muscularis of the bowel. The clinical picture, roentenographic findings, pathology, and pathophysiology of this condition are discussed.


Clinical involvement of mesenteric and antimesenteric borders of small bowel loops. I. Normal pattern and relationships. Anatomic features of the mesentery, as it contributes to the characteristic course and coiled nature of small bowel loops, are analyzed in detail. An understanding of the anatomic definition and relationships of the loops of small intestine permits roentgen identification of their mesenteric and antimesenteric borders. It is established that (a) the concave margin of a small bowel loop, facing toward the axis of the root of the mesentery, is the mesenteric border; and (b) the convex margin of a small bowel loop, facing away from the axis of the root of the mesentery, constitutes the antimesenteric border. The ability to distinguish between the mesenteric and antimesenteric borders of small bowel loops further refines the capabilities of radiologic diagnosis in a variety of intraabdominal disease processes.


Gastric antral diaphragm.

Gastric antral diaphragm. Roentgenographic abnormalities in 3 patients with antral diaphragm are presented. Barium studies revealed the diaphragm as a persistent, circumferential defect in the distal antrum, often associated with peptic ulcers or gastric outlet obstruction. At endoscopy the central aperture does not change during peristalsis in contrast to the pylorus, which does. Since the lesion can be excised, its preoperative demonstration by barium studies and endoscopy is emphasized.


Abdominal desmoid masses in Gardner's syndrome. Abdominal masses, "desmoid tumors,"  occur in approximately 4% of patients with Gardner's Syndrome, usually 1--3 years after total colectomy. Histologic sections usually resemble those of an infiltrating fibrous tumour, a desmoid lesion. The radiographic pattern may be similar to any diffuse abdominal retroperitoneal tumor, metastatic disease, lymphoma, or possibly retractile mesenteritis. The clinical setting usually differentiates these entities.


The Japanese-style double-contrast examination of the stomach. Western radiologists are using the Japanese-style double-contrast examination of the stomach with increasing frequency. Extensive experience now indicates that the double-contrast technique greatly increases the accuracy of the radiologic examination of the stomach. Lesions characterized by small irregularities in the mucosal surface of the stomach, such as superficial carcinomas, small or shallow ulcers, gastric erosions, and ulcer scars, are particularly apt to be detected only by double-contrast technique. The double-contrast study also increases the detectability of lesions in the proximal stomach, where compression and palpation are difficult to apply effectively.


Lesions associated with familial polyposis coli: studies of lesions of lesions of the stomach, duodenum, bones, and teeth. The entire gastrointestinal tract and bones were examined systematically in 24 patients (10 pedigrees) in whom familial polyposis coli was diagnosed. Polypoid lesions were observed in the stomach in as high as 68.2% of the cases, and in the duodenum in 90%. Abnormalities were noted in the skeleton in 50% and in the mandible in 81.3%. The authors emphasize the possibility that familial polyposis coli is substantially the same entity as Gardner's Syndrome.